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• • <br />PERMIT APPLICATION <br />BUILnING/IVIECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: <br />'`. � i u i-- ... _ <br />LEGAL for new construction: Short Plat/subdivis <br />�`� i�.5 �-1 �� <br />PROPERTV TAX # <br />No. (attach copy of long legal description) <br />�l � /?l;L�, <br />WNER ..,,: V \ ;� Phone/E- -� �— � '; �;L `k �:'�t� �';;��. <br />idress �-. �� � ��-��/ yL,s CitylState/Zip �� 7 �; _ � a.� �� � <br />PPLICANT: _/Owner _ Owner's Agent _ Contractor _ Contractor�S Ag0f1l _ T8f18f11 (must provide a letter of consent from the owner to do work in the space) <br />CONTRACTOR <br />ress <br />State Lic. # <br />�Phone/Email <br />CONTACT FOR PERMI(I°► <br />City Bus. Lic. # <br />_Qo�_- Gl l <br />�-�-� � �- ,_.�— <br />�� Z� �..�(�C � ;��. l_) .�� C�.� ., ��`�-° Phone/E-mail '` d "- � �C�� :1�1 � <br />BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK k:^, C c"c� <br />Existing Use of Building � G✓� �-t�'--�-\ � 41�'z w' <br />Proposed Use of Building t-�; -�� � G ch.V <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family /Commercial <br />Type of project: New �Addition Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />HEAT SOURCE: <br />✓Electric -/ <br />Demolition Chanqe of Use <br />�� <br />� ` (� <br />��t c � Y��.�. �� r� � L.;jc� `; � .�n ���.c � ( ��� '� L 1`1J�o �C <br />�.. � �j�C \ ' � <br />C�r.. �A�� <br />MECHANICAL PERIIi91T APPLICA'�ION <br />of Project: _New _�Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C - air handling units <br />� Forced air systems <br />j Gas piping <br />; Water heater <br />j Gas fireplace <br />'j Gas range <br />Clothes dryer <br />Range hood <br />�; Exhaust fan <br />j Heat pump <br />; Unit heater <br />' B iler <br />efrigeration <br />Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />j Toilet <br />i Bathtub <br />� Lavatory (wash basin) <br />j Shower <br />; Kitchen sink & disposal <br />; Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />; Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />i Grease trao <br />rcoot arains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authorized by the owner of this property to periorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. r <br />�J � <br />C 6 % �? - i3 <br />Owner/Authorized Agent Signature Date (Revised 3/2013) <br />